Psoriasis is a skin disease hallmarked by red, scaly skin that can be painful or hot to the touch, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); and while it's definitely not a fun thing to suffer through, it's relatively common (about eight million Americans have it, per the National Psoriasis Foundation).
But psoriasis is kind of an umbrella term; there are actually five different types of the skin disease, per the NIAMS: plaque psoriasis, guttate psoriasis, pustular psoriasis, inverse psoriasis, and erythrodermic psoriasis—the last of which is likely the most severe kind, only occurring in about three percent of all those with psoriasis.
What exactly is erythrodermic psoriasis?
So, psoriasis in general is an autoimmune disease, per the NIAMS, which means it triggers a response in your immune system (that's why psoriasis isn't contagious—it's not caused by anything that can come into contact with your skin). That immune response then leads to swelling and a faster turnover of cells. Basically, the red, scaly patches are a result of your skin growing too quickly and piling on the surface—and in typical psoriasis, this only really happens on the scalp, elbows, or knees. But in erythrodermic psoriasis, the inflammatory response is much more severe and manifests in very large sections of the body becoming red, scaly, and flaky.
“When you have erythrodermic psoriasis, your skin tends to peel in large sheets,” says Suzanne Friedler, MD, a dermatologist at Advanced Dermatology and a clinical instructor of dermatology at Mount Sinai Medical Center in New York City. “This also leads to other systemic problems such as dehydration and temperature and electrolyte imbalances.”
Another big issue? Erythrodermic psoriasis patients also tend to struggle with regulating their body temperature due to their flaking skin. "Patients fluctuate between fever and chills, says Adarsh Vijay Mudgil, MD, a dermatologist and dermatopathologist in New York City. And in some rare cases, "life-threatening complications can occur," says Ohara Aivaz, a dermatologist in Beverly Hills, California. “These include skin and blood infections as well as kidney failure.”
What causes erythrodermic psoriasis?
First things first: Erythrodermic psoriasis will only affect those who already have psoriasis in general. Experts aren’t totally sure what causes this severe psoriasis subtype, but according to the National Psoriasis Foundation (NPF), it often shows up more in those who have unstable plaque psoriasis (when psoriasis lesions aren't clearly defined).
Erythrodermic psoriasis might be triggered by various things, per the NPF, including abrupt withdrawl of systemic treatment (like corticosteroids), severe sunburn, infection, emotional stress, or even alcoholism. “In addition, it’s important to note that patients with HIV have a higher chance of their psoriasis turning into the erythrodermic form," says Dr. Tonkovic-Capin.
What does treatment look like for erythrodermic psoriasis?
Your first line of treatment is topical steroids to help reduce inflammation, along with moisturizers, wet dressings, and bed rest, to help with the pain and itching. If that doesn't work, and your psoriasis can't be controlled at home, you may need to get treated in a hospital setting, where fluid depletion can be readily handled via IV fluids. In addition, treatment for this form of psoriasis includes the use of topical steroids and systemic immunosuppressive medications as well as ongoing cardiac and pulmonary monitoring.
“We usually start the patient on warm wet wraps with a topical steroid, infusions of electrolytes if needed and such psoriasis medications as oral cyclosporine or infusions of infliximab,” says Viseslav Tonkovic-Capin, MD, a dermatologist and dermatopathologist in Kansas City.
Patients are also routinely monitored for a whole variety of other complications that may ensue. “For example, for these patients, we always do regular blood and skin cultures to check for infections,” says Dr. Tonkovic-Capin. “Most important: We start antibiotics right away because infections are the main reason for death among those with erythrodermic psoriasis.”
In the end, due to the seriousness of erythrodermic psoriasis, it’s essential for patients to be in constant contact with your dermatologist in order to get all the help you need to manage your care and navigate your treatment options.